Cataract scheme 'expensive over-reaction' say doctors

The independent sector treatment centre (ISTC) scheme for NHS cataract services was an expensive over-reaction to the need to increase rates of cataract surgery, say senior doctors in this week's BMJ.

Many ophthalmology departments had improved cataract surgery pathways before the ISTC programme was proposed, writes Consultant Ophthalmic Surgeon, Simon Kelly in a letter signed by the President and Vice President of the Royal College of Ophthalmologists and the Chair of the BMA's Ophthalmic Group Committee.

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Had the Department of Health followed the advice of clinicians, the royal colleges, and the BMA when the cataract and other ISTC schemes were proposed, improved access to cataract surgery would have been realised with much less expenditure, without adverse effects on surgical training, and without destabilising NHS eye departments.

However, an alternative direction was taken, they say. And despite the paucity of clinical outcome data, and the lack of evidence of cost effectiveness of phase 1 of the ISTC programme, further investment in cataract surgical facilities continues in phase 2.

Meanwhile, for long term stability of the service, the best option for the public is to support local NHS units, which brought down cataract waiting times, which patients need to call on in an emergency or for chronic eye disease, and which train the next generation of surgeons while meeting waiting time targets.

A constructive partnership of clinicians, managers, and commissioners is a surer way to achieve sustained improvements in access and quality of care, rather than centrally imposed initiatives and diktat, such as the needless cataract ISTCs, they conclude.

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